Settlement Of Claims Research Articles

ANALISIS PENGAKUAN PENDAPATAN DAN BEBAN MENURUT PSAK NO. 28 PADA PT. ASURANSI TRI PAKARTA CABANG MANADO

Uniformity in the preparation of a financial report needs to be done to get the results of a financial report is good and trustworthy. For that every company needs to implement the applicable accounting standardization in order to create information that is easily understood by users of information. In a financial statement of the most important is the recognition of revenues and expenses in accordance with the applicable standardization. The purpose of this study was to determine the recognition of revenues and expenses made by PT. Tri Pakarta insurance in accordance with the standardization that exists is under PSAK No. 28 about insurance. The method used is descriptive analytical method, which is a method of research based on the search data- data will then be analyzed and described later concluded in accordance with the purpose of this study. From these results it can be concluded that PT. Insurance Tri Pakarta has made the recognition of revenues and expenses that have taken the appropriate standardization of existing ie, revenue is recognized based on the contract effective or calculated in accordance with its useful life, and the burden of claims in connection with the events of loss to the insurance objects insured, covers claims approved (settled claims), claims in process (outstanding claims), claims incurred but not yet reported and claim settlement expenses (claims settlement expenses), recognized as an expense claim when there is an obligation to meet claims or losses when the report came up.Keywords : Revenues, Expenses, Insurance, PSAK NO. 28

Use of Dimensional Analysis in an Associate Degree Nursing Program

The aim of this retrospective study was to show the use of dimensional analysis increased associate degree nursing students’ mathematical computation competency and may reduce nursing medication errors in practice. A recent report compiled by Mackary and Daniel from John Hopkins, stated that medical error is the third leading cause of death in the United States [1]. The most commonly cited estimate of annual deaths from medical error in the United States is a 1999 Institute of Medicine (IOM) report which is possibly limited and now outdated [2]. Medication errors contribute to patients’ deaths, whereas nurses administer either incorrect medication, or incorrect doses of medication. Human error is inevitable, however designing safer systems to administer medication such as the use of a bar code system, and the standardization of academic medication calculation teaching may decrease these errors. According to a report from a major insurance company that insures a large percentage of nurses, malpractice claims in nursing is on the rise [3]. Claim settlements and court judgments for 2015 against nurses include: failure to communicate, medication errors, charting by exception, and legal risks. Medication calculation errors can be one of three categories, conceptual, mathematical, and measurement, with conceptual errors (setup of the calculation equation) accounting for 68% of all errors [4]. Nursing textbook publications teaching dose calculation often use multiple methods: ratio-proportion, “desired over have”, and various formulas to calculate medication dosage. Students then need to use the appropriate formula to solve the problem with fractions often leading to miscalculations with added or dropped zeroes. The use of dimensional analysis (DA) only requires the student to use a single equation, and learn one calculation process, rather than several steps required by other methods or even memorization of multiple formulas [5].

Proposed Model for Measuring Customer Satisfaction with Telecommunications Services

AbstractThe aim of this article is to propose a model for measuring customer satisfaction in users of telecommunications services. The methodological design is quantitative descriptive and explanatory type, using a survey as data collection tool, with a sample of 415 users of telecommunications services (landline telephone, television and Internet services) in the city of Medellin. Among the results, it is found that the service in the Call Centers and timely response to requests, inquiries, or complaints, and an effective service are among the factors that have the most influence in the satisfaction of users of telecommunications services. In addition, it is noted that the perception of a favorable cost-benefit services is influenced by the offered plans and promotions, and the proper settlement of claims and applications in their companies, showing that these are issues that need to be strengthened in telecommunication services companies.

Tort Tactics: An Empirical Study of Personal Injury Litigation Strategies

This article reveals some of the tactics which lawyers may use when conducting personal injury litigation. The research is empirically based by being drawn from structured interviews with a cross section of practitioners. This qualitative evidence helps to place the rules of tort in a wider context and suggests that tactical considerations may affect the outcome of individual cases irrespective of their legal merits. A range of strategies are considered here to illustrate how they may be used at different points during the litigation. In addition, the article updates our understanding of the compensation system by considering the practitioners’ responses in the light of the major changes made to this area of practice in recent years. It reveals how negotiation tactics have developed since research in this area was last carried out. Overall the article adds to a very limited literature dealing with negotiation and settlement of personal injury claims in the U.K. The picture of litigation painted here runs counter to the misleading image of individualised court-based justice that is often portrayed as the defining characteristic of tort law. For a You Tube lecture based on some of this publication see https://www.youtube.com/watch?v=XShI_gXYni8

Tort tactics: an empirical study of personal injury litigation strategies

This paper reveals some of the tactics that lawyers may use when conducting personal injury litigation. The research is empirically based by being drawn from structured interviews with a cross-section of practitioners. This qualitative evidence helps to place the rules of tort in a wider context and suggests that tactical considerations may affect the outcome of individual cases irrespective of their legal merits. A range of strategies are considered here to illustrate how they may be used at different points during the litigation. In addition, the paper updates our understanding of the compensation system by considering the practitioners' responses in the light of the major changes made to this area of practice in recent years. It reveals how negotiation tactics have developed since research in this area was last carried out. Overall, the paper adds to a very limited literature dealing with negotiation and settlement of personal injury claims in the UK.

샌프란시스코 平和條約에 따른 ‘Korea/朝鮮’의 獨立承認과 韓日 間 請求權解決에 關한 一 考察

국제법상 현재는 과거와 긴밀히 연결되어 있다. 과거는 역사 속에 숨어 있다가 어느 순간 현실에 나타나서 국제법적 담론의 주제가 된다. 이러한 예를 한일관계에서 쉽게 찾을 수 있다. 1910년 이후 1965년까지 한일관계는 파란만장하였다. 이 시기는 1910년 병합조약으로 시작되었다. 이 조약에 의하여 일제는 한반도를 지배할 수 있게 되었고, 일제의 한반도 지배는 1945년 8월 패전으로 끝났다. 1950년 이후 한반도에서 전쟁이 한창일 때 일본은 새로운 도약의 기회를 얻게 되었다. 동북아시아에서 냉전체제가 형성되면서 일본은 패전국이지만 전승국과 대등한 입장에서 1951년 샌프란시스코 평화조약을 체결할 수 있었다. 샌프란시스코 평화조약에서는 ‘Korea’의 독립승인 규정에 의하여 주권을 회복하는 주체가 누구인지를 명시하지 않고 있고, 소위 ‘분리된 지역’ 내 일본 재산의 처리와 관련해서 해당 지역 내 시정당국과 일본이 특별협정을 통해서 해결하도록 하였기에 전후처리방식과 관련해서 많은 문제를 야기하였다. 특히, 한일관계에서는 1910년 병합조약의 무효 여부, 대한민국의 영토적 관할 범위, 일제 강점기 피해에 대한 배상처리 문제 등으로 인하여 한일 양국이 1965년 정상적인 국교를 수립할 때까지 10년 이상 한일회담이 지속되었다. 그런데도 군대위안부 등 일제강점기 피해로 인한 배상처리와 관련한 사항은 아직까지 해결되지 않은 상태이고 이들 문제의 근원은 일본에게 직접적인 전쟁책임을 부과하지 않은 샌프란시스코 평화조약의 맥락에서 이해할 수 있다.

PENGARUH PENYELESAIAN KLAIM ASURANSI TERHADAP PENCAPAIAN TARGET PENJUALAN PRODUK ASURANSI AJB BUMIPUTERA 1912 CABANG BENGKULU

Sri Handayani; Insurance claims are the demands of the insured party in connection with the contract between the insurer with the insured person that each of the parties bind themselves to guarantee the payment of compensation by penaggung if insurance premium payments have been made by the insured party, when the disaster suffered by the insured person. This study aimed to examine the effect of the settlement of insurance claims against insurance product sales target AJB BUMIPUTERA 1912 Cabang Bengkulu. The sample in this study is the settlement of insurance claims and insurance product sales target AJB BUMIPUTERA 1912 Cabang bengkulu observation period of 5 years. The method used is the correlation coefficient. These results indicate that a growing number of insurance claims are settled, the higher the achievement of sales of insurance products offered AJB BUMIPUTERA 1912 cabang Bengkulu.Key words: Insurance claims

Effect of Claim Settlement Practices on the Operating Efficiency and Profitability of Life Insurance Companies of India-A Comparative Study of Public and Select Private Sector

Claim settlement management is the one of the most important service that comes under the crucial quality of life insurance service. The objectives formulated in this study are to study the claims settlement practices of public and select private sector life insurance companies, India and to analyze the effect of claim settlement practices on the operating efficiency and profitability performance of public sector and select private sector life insurance companies, India. The exploratory research design is applied. The convenient sampling technique is used for selecting the companies from the life insurance industry which constitutes 87.07% share in the industry as per IRDA Annual report 2009–10. The LIC of India is the only one state owned firm in the public sector and ICICI Prudential Life Insurance, HDFC Life Insurance, SBI Life Insurance and Bajaj Allianz Life Insurance companies under private sector were taken as sample. The IRDA annual reports and the selected company annual reports from 2001–02 to 2012–13 were used for collecting the required data. The various benefits such as maturity benefits, death claims, annuity, etc., paid to the policy holders by the select public and private sector companies are analyzed. Operating efficiency of life insurance companies are calculated by using data envelopment analysis tool with the dea online software. The market share (MS), Return on Assets (ROA), Claim Settlement Ratio (CSR) and Claim Rejection Ratio (CRR) were calculated. These are analyzed by using statistical tools such as linear growth rates, compound annual growth rates, and coefficient of variance, mean and coefficient of correlation. The analyzed reveals that LIC of India is the industry leader not only in sale of policies but also in the benefit payments. In overall benefit payments among the select private sector life insurance companies, ICICI Prudential Life insurance was the top performer followed by HDFC Life insurance, Bajaj Allianz life insurance and SBI Life insurance. It is concluded that the claim settlement practices of life insurance industry had statistically significant impact on their profitability as well as operating efficiency. More-over, claim settlement practices of select life insurance players had statistically significant positive impact on the profitability but they had statistically significant negative impact on their operating efficiency due to increased operational risk for enhanced sales or more underwritten policies Hence companies should maintain optimum claim settlement practices to achieve good market share and profitability.

Evaluating Cyber Infrastructure for Cyber-Insurance in the Corporate World: An Analytical Focus.

In this world of 'big data', having the right data available at the right time is crucial; and it is an imperative that has moved far beyond the remit of IT alone. The dreamt IT3G (Information Technology Generated Global Governance ) village is facing some of the challenge in the IT enabled corporate e-market (ITeC), realise it for future long term existence with dynamic resistant technology, though it is changing to surpass civilisation from one millennium to another. Is it bane or boon? That is too difficult to predict on this short span of subject and technological form of life in the market as well as environment of business in the world. The world production, investment, capital formation and operation of business through this new technology, salvage itself from the new ghost of cyber crime. Organisations recognise their data as the asset for the future business and operation factor. This accounting and evaluating process is a top – down process, once it is take up into a working principle and culture then business will be somehow riskless for this ITeC. The risk factors are involved with this spawning cyberinsurance itself with some new business cost, huge to both business organisations with data and cyber related matter on this current business scenario. This empirical study is based on the new frame and principle for valuating the cyber asset of the corporate organisation, as a good solution to future insurance disbursement and claim settlement.

Changing Cyber Infrastructural Insurance for Dynamic Data Bank: An Analytical Focus

Information Technology is a revolution for the 21st century. Different dynamism may be meritorious or crime. In this world of 'big data', having the right data available at the right time is crucial; and it is an imperative that has moved far beyond the remit of IT alone. The dreamt IT3G (Information Technology Generated Global Governance ) village is facing some of the challenge in the IT enabled corporate e-market (ITeC), realise it for future long term existence with dynamic resistant technology, though it is changing to surpass civilisation from one millennium to another. Is it bane or boon? That is too difficult to predict on this short span of subject and technological form of life in the market as well as environment of business in the world. The world production, investment, capital formation and operation of business through this new technology, salvage itself from the new ghost of cyber crime. Organisations recognise their data as the asset for the future business and operation factor. This accounting and evaluating process is a top–down process, once it is take up into a working principle and culture then business will be somehow riskless for this ITeC. The risk factors are involved with this spawning cyberinsurance itself with some new business cost, huge to both business organisations with data and cyber related matter on this current business scenario. This empirical study is based on the new frame and principle for evaluating the cyber asset of the corporate organisation, as a good solution to future insurance disbursement and claim settlement.

Engineer's Guide to PI Claims. Part 10: Recoveries and contributions

Our series from Griffiths & Armour continues by examining the issues involved in bringing a recovery action following settlement of a professional indemnity claim.

Prediction of Settlement Delay in Critical Illness Insurance Claims by Using the Generalized Beta of the Second Kind Distribution

SummaryWe analyse the delay between diagnosis of illness and claim settlement in critical illness insurance by using generalized linear-type models under a generalized beta of the second kind family of distributions. A Bayesian approach is employed which allows us to incorporate parameter and model uncertainty and also to impute missing data in a natural manner. We propose methodology involving a latent likelihood ratio test to compare missing data models and a version of posterior predictive p-values to assess different models. Bayesian variable selection is also performed, supporting a small number of models with small Bayes factors, and therefore we base our predictions on model averaging instead of on a best-fitting model.

The Use of the Process Approach and BPM-System for Department of Claim Settlement

The Use of the Process Approach and BPM-System for Department of Claim Settlement

Predictors of time to claim closure following a non-catastrophic injury sustained in a motor vehicle crash: a prospective cohort study.

BackgroundResearch suggests that exposure to the compensation system (including time to case closure) could adversely influence a persons’ recovery following injury. However, the long-term predictors of time to claim closure following minor road traffic injuries remain unclear. We aimed to assess a wide spectrum of factors that could influence time to claim closure (socio-demographic, compensation-related, health, psychosocial and pre-injury factors) over 24 months following a non-catastrophic injury.MethodsProspective cohort study of 364 participants involved in a compensation scheme following a motor vehicle crash. We used a telephone-administered questionnaire to obtain information on potential explanatory variables. Information on time to claim closure was obtained from an insurance regulatory authority maintained database, and was classified as the duration between the crash date and claim settlement date, and categorized into < 12 (early), > 12–24 (medium) and > 24 months (late).ResultsJust over half of claimants (54 %) had settled their claim by 12 months, while 17 % and 30 % took > 12–24 months and > 24 months for claim closure, respectively. Whiplash at baseline was associated with claim closure time of > 12–24 months versus < 12 months: multivariable-adjusted OR 2.38 (95 % CI 1.06–5.39). Claimants who were overweight/obese versus normal/underweight at the time of injury were ~3.0-fold more likely to settle their claim at > 12–24 months than < 12 months. Consulting a lawyer was associated with a 10.4- and 21.0-fold increased likelihood of settling a claim at > 12–24 months and > 24 months, respectively. Each 1-unit increase in Orebro Musculoskeletal Pain Screening Questionnaire scores at baseline was associated with greater odds of both medium (> 12–24 months) and delayed claim settlement date (> 24 months): multivariable-adjusted OR 1.04 (95 % CU 1.01–1.07) and 1.02 (95 % CI 1.00–1.05), respectively.ConclusionsAround a third of claimants with a minor injury had not settled by 24 months. Health-related factors and lawyer involvement independently influenced time to claim closure.

Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District

BackgroundGhana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. ObjectivesThis article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. MethodsMedical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. ResultsIn all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. ConclusionsThere is increased value of the NHIS benefit package to subscribers; however, the scheme’s responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality.

Rehab Therapy Provider Pays $125 Million in False Claims Settlement

Rehab Therapy Provider Pays $125 Million in False Claims Settlement

Current trends of the assistance development in the insurance market of Ukraine

The main indicators of assistance activity in the insurance market in Ukraine have been analyzed. Beneficial and negative trends of its development have been shown. The dynamics of the insurers' liquidation expenses structure and the payment of services expenses of the assistance establishments have been highlighted. Their structure has been shown due to the types of voluntary and compulsory insurance. The main problems hindering the effective development of the assistance services market have been characterized and the prospects of its development have been offered.The aim of the research is to carry out comprehensive analysis of the current market of assistance services, to identify the main problems of their implementation and to point out the prospects of insurance market development.The dynamics of insurance bonuses and benefits including insurance compensation and services and the insurers' operating expenses concerning the payment of services of the assistance establishments has been analyzed on the basis of a sample survey of the main indicators of insurance market development due to the statistic data of National Committee of Financial Services. It has been revealed that majority of the insurance services provide settlement of insurance claims by offering assistance service. Alongside increasing of the share of insurance payment due to the contract providing the insurance service, allows the majority of insurance claims to be settled due to the payment of insurance compensation.Expenses on assistance services were the highest and the court expenses were the lowest in the structure of the insurer's liquidation expenses during 2011-2014. Expenses on services of the non-residential assistance establishments are low but they are increasing. It shows that emergency assistance to our citizens in the country and outside is being increased.Structure of assistance services in the voluntary and compulsory insurance market has been analyzed; main trends of assistance activity development according to the separate insurance services have been highlighted. In particular it was found out that the greatest amount of assistance services were provided due to the voluntary medical insurance, medical costs insurance, land transport insurance and compulsory insurance of civil liability of the owners of vehicles.On the basis of conducted analysis, we can draw a conclusion about the low level of assistance services market development. It is affected by negative trends of economic and political crisis, low solvency of insurers and the quality of insurance services, a lack of guaranties to provide emergency assistance in time, imperfect state regulation of assistance services provision, and a low level of institutional support. We offer to intensify the interaction between the insurers and assistance companies while providing insurance services including additional ones, insurance compensation, and settlement of insurance claims by ensuring emergency assistance in monetary and natural-material form. This will promote the increasing of quality of the insurance protection.

Analysis of Insurance Claim Settlement Process with Markovian Arrival Processes

This paper proposes a model for the claim occurrence, reporting, and handling process of insurance companies. It is assumed that insurance claims occur according to a Markovian arrival process. An incurred claim goes through some stages of a claim reporting and handling process, such as Incurred But Not Reported (IBNR), Reported But Not Settled (RBNS) and Settled (S). We derive formulas for the joint distribution and the joint moments for the amount of INBR, RBNS and Settled claims. This model generalizes previous ones in the literature, which generally assume Poisson claim arrivals. Due to the flexibility of the Markovian arrival process, the model can be used to evaluate how the claim occurring, reporting, and handling mechanisms may affect the volatilities of the amount of IBNR, RBNS and Settled claims, and the interdependencies among them.

Stochastic model to evaluate the fair value of motor third-party liability under the direct reimbursement scheme and quantification of the capital requirement in a Solvency II perspective

As commonly known, to evaluate the claims reserve (otherwise known as the provision for outstanding claims), the loss adjuster uses as a first component the claims reserve given by the sum of the estimated provision for each outstanding claim (known as case reserve). Traditional statistical-actuarial methods are used to control and/or asseverate the evaluation and recent developments have tended to ensure that these enable an independent assessment of the claims reserve. In some European countries, a large subset of motor liability claims is managed within a direct reimbursement (DR) scheme. In Italy, the introduction of the direct compensation CARD system for third-party liability insurance has resulted in greater attention in the use of these traditional methods due to the heterogeneity of the data available for evaluations. This paper presents the results of a study undertaken to define a calculation method that, using the different assumptions that describe the evolution of settlement mechanisms, is able to quantify the claims reserve. The proposed methodology reduces the loss adjuster’s discretion in applying statistical methods since all assumptions must be made explicit and can hence be monitored and controlled. Furthermore, a stress test can be performed on all the parameters that influence the settlement and thus the claims reserve. Finally, in a backtesting perspective, the proposed methodology enables an ex-post analysis of actual cash flow deviations compared to expected values, identifying the variables that lead to these differences. In particular, a calculation method is presented that using the different assumptions describing the evolution of the settlement of different claim handling procedures (Non-Card, Card, Handler Forfait and Debtor Forfait) is able to quantify the claims reserve. Via simulations, future payments, the expected value of the claims reserve and some indicators of variability are also estimated. The numerical application allows comparing the results obtained with those deriving from the application of traditional statistical methods.The problem of aggregating the four claim handling procedures is dealt with by using copulas with the goal of building a single distribution of the aggregate claims reserve. Furthermore, in a Solvency II perspective, the capital requirement is determined against the reserve risk based on the internal model proposed and is compared with the standard formula proposed by EIOPA.

Taking a Financial Position in Your Opponent in Litigation

Before filing suit, a plaintiff can take a financial position in a defendant firm. A short position benefits the plaintiff by transforming a negative expected-value claim into a positive expected-value one and by enhancing the claim's settlement value. If the capital market is less than strong-form efficient, the plaintiff also benefits directly from the decline in the defendant's stock price. When the defendant is privately informed about the case's merits, bargaining failures can arise. While aggressive short-selling benefits the plaintiff at the expense of the defendant, moderate levels of short-selling can benefit the defendant and raise the settlement rate. (JEL D82, G14, K41)